Another Decision Requiring DHHS Medicaid to Cover Disposable Diapers for an Adult Due to Medical Necessity

November 2006

The DHHS Administrative Appeals Unit has issued another decision finding that disposable diapers must be covered by Medicaid. The hearing officer found that disposable diapers for Ryan, age 22, were medically necessary and therefore a covered service under the Medicaid rules, He-W 530.05(c).

The hearing officer found that Ryan’s quality of life and his ability to access the community would be significantly affected if he had to use cloth diapers.

DHHS had argued at the hearing that medical supplies are an “optional service” in the state plan, and therefore not a “covered service”, apparently misinterpreting the meaning of “optional service”. The hearing officer found that disposable diapers may be considered a “medical supply” under the plain meaning of the term, that the state plan covers medical supplies, and that DHHS did not have a rule excluding disposable diapers specifically.

4-17-07: Since this decision has been issued, there have been rule changes and legislation concerning medically necessary services and supplies.

Please note: As with an earlier decision, this does not mean all adults who use disposable diapers will now have those diapers covered under Medicaid.

For further information, contact Disability Rights Center - NH at 1-800-834-1721

 

updated September 8, 2015